Volunteer

This agency does not discriminate on the basis of race, religion, age, gender, disability, national origin, political affiliation, sexual orientation, medical condition, or any other non-performance factor.

Name *

Email *

Phone Number *

Address *

City and State *

Date of Birth *

Gender

Female

Male

I am interested in:

Community Education

Court Advocacy

Crisis Line Advocacy

Office Volunteer

Event Volunteer

Other

Or volunteer in another capacity:

Are you currently employed?

Yes

No

If Yes, Where are you employed?

How did you hear about Families Living Violence Free?

Do you speak a second language? If so, which language?

Expected length of volunteer commitment

Past relevant experience, if any

What experience do you hope to gain through volunteering?

Do you have any personal experience with domestic violence or sexual assault victims/survivors?

Have you ever been arrested or convicted for a criminal offense, other than minor traffic violations?

Yes

No

If yes, please explain.

Any additional comments or questions?

References:

Name

Phone Number

Name

Phone Number

By checking the box below, I certify that all of the above information is true to the best of my knowledge.